Provider Demographics
NPI:1144061565
Name:EVANS, ASELEFECH WEYESA (LSWAIC)
Entity type:Individual
Prefix:
First Name:ASELEFECH
Middle Name:WEYESA
Last Name:EVANS
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:ASELEFECH
Other - Middle Name:WEYESA
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ASELEFECH EVANS
Mailing Address - Street 1:600 1ST AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2287
Mailing Address - Country:US
Mailing Address - Phone:206-607-7084
Mailing Address - Fax:
Practice Address - Street 1:600 1ST AVE STE 102
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2287
Practice Address - Country:US
Practice Address - Phone:206-607-7084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC614863141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical